ERCP在胰胆管合流异常相关疾病中的诊治进展

1916年日本学者Kozumi在对1例先天性胆总管囊肿患者进行解剖时,首先发现了合并胰胆管合流异常。1969年美国Babbit首次提出了胰胆管合流异常的概念,随后胰胆管合流异常被证实与许多胆道疾病和胰腺疾病（如先天性胆总管囊肿、胆石症、胆囊癌、胰腺炎等）密切相关。ERCP因可直接观察胆胰系统并清楚显示胰胆管解剖异常而成为诊断胰胆管合流异常的金标准。本文就ERCP在胰胆管合流异常相关疾病中的诊治进展作一综述。一、胰胆管合流异常的形成及诊断胰胆管合流异常是指胰管、胆管在十二指肠壁外汇流的先天性解剖畸形,造成共同通道过长,使十二指肠乳头部括约肌的作用不能作用于汇流部,导致胆汁、胰液相互混合引起逆流,而发生胆道及胰腺的各种疾病。     

胰胆管合流异常对胰腺损伤的实验研究

目的 探讨胰胆管合流异常(APBDU)对胰腺的损伤.方法 选择健康杂种猫10只,在胆管、胰管近十二指肠处纵行切开4～6 cm,然后间断吻合,以建立胰胆管合流异常的模型.手术造模时及术后6个月分别取胰腺组织行病理检查、电镜观察及胰腺组织丙二醛(MDA)水平检测.结果 7只猫生存6个月.术后6个月胰腺呈暗红色,充血、水肿,其中3只猫胰腺表面可见扩张的胰管.光镜下见3只猫胰腺有炎性细胞浸润,4只猫胰腺有间质血管增生、白细胞附壁.电镜下见胰腺腺泡细胞粗面内质网扩张,有的呈池状;线粒体数量增多、体积增大、崩解;高尔基复合体发达.手术前胰腺组织MDA水平为(1.23±0.7)nmol/mg prot,术后6个月升高达(2.90±1.9)nmol/mg prot,相差显著(F=4.80,P=0.0215).结论 胰胆管合流异常可导致胰腺损伤,抗氧化可能有助于减轻该损伤.     

小儿胰腺炎与胰胆管合流异常临床分析

目的探讨小儿胰腺炎和胰胆管合流异常（APBDU）的关系。方法选择以腹痛、呕吐为主要表现入院诊断为胰腺炎的患儿18例,并与进一步行腹部肝胆胰腺B超、CT检查和核磁共振胰胆管成像等影像学检查有胰胆管病变的患儿进行对比研究。结果 18例患儿中诊断急性胰腺炎14例,慢性胰腺炎4例。18例胰腺炎患儿先天胆总管扩张6例,胆管扩张1例,胆总管囊肿5例,APBDU 6例（不伴胆管扩张）。9例接受手术治疗6,例胰腺炎治愈,3例好转;1例胰腺胸膜瘘患儿接受ERCP支架扩张术治疗病情好转出院;7例内科保守治疗临床稳定出院;1例未愈。结论 APBDU是导致胆源性胰腺炎的重要原因之一,寻找胰腺炎患儿潜在的胰胆管解剖学上发育异常和异常胆道病变,利于病因治疗、提高预后。     

逆行胰胆管造影的临床应用

经十二指肠镜插管的逆行胰胆管造影(ERCP),国内外均获迅速的发展。此项检查对全面诊断和研究胆道、胰腺疾病起了很大推动作用。现就对ERCP的评价讨论如下。ERCP的优点和进步:胰腺头部的胰管和总胆管     

胰胆管合流异常的研究进展

随着人们对胰胆管合流异常(pancreaticobiliary maljunction,PBM)的认识增加,PBM得到了越来越多的重视.PBM与先天性胆管囊肿、胆道结石、非结石性胆囊炎、胆道肿瘤及胆源性胰腺炎等胆胰疾病关系密切,但目前对于胰胆管合流异常相关疾病的发病机制以及治疗等方面还没有完全统一的观点.本文就目前对胰胆管合流异常的研究进展作一综述.     

胰胆管合流异常影像学诊断和外科治疗原则探讨

目的分析胰胆管合流异常的影像学诊断特点,探讨如何选择合理的手术治疗.方法回顾性分析64例胰胆管合流异常症患者的影像学特点和治疗结果.结果64例患者的胰胆管共同通道平均长度是(19.0±0.6)mm.胰管型患者28例(占43.8%),胆管型32例(占50%),共同通道型4例(占6.2%).对胆肠囊状扩张患者行囊肿切除术,加胆肠吻合术;胆道结石患者行胆囊切除术;对晚期肿瘤行保守治疗,其余肿瘤患者行根治术.结论胰胆管合流异常同许多胆道、胰腺疾病的发生有密切关系.在临床工作中早发现该症患者,给予合理的手术治疗可避免严重合并症的发生.     

腹腔镜胆道造影在腹腔镜胆道手术中的作用

腹腔镜胆道手术最常见的手术并发症是胆道残余结石及胆管损伤。临床上常用的与胆石症相关的术前检查均具有一定的局限性。腹腔镜术中胆道造影的方法可以明确肝内外胆管结石的情况,预防术后胆道残余结石发生,预防和及时发现术中胆管损伤,提高胆管损伤修复的成功率。因此,掌握术中胆道造影的适应证并合理应用,具有重要的临床意义。本文从腹腔镜术中胆道造影的意义、腹腔镜术中胆道造影的适应证、方法及注意事项等几方面就胆道造影在腹腔镜胆道手术中的应用现况加以评述。     

急性重症胆管炎

急性重症胆管炎(ACST)是胆道良性疾病中的主要死因,病死率高达50％。 1.病因:主要病因是胆管的梗阻和细菌感染。肝内外胆管结石、胆管炎性狭窄、胆管肿瘤、胰腺炎症或肿瘤、十二指肠乳突狭窄、胆管先天畸形、胆道蛔虫症等均可造成梗阻,其中肝内外胆管色素结石最常见。不完全性梗阻病情较缓和,治疗后可缓解,但易反复发作。其致病菌主要是大肠杆菌、副大肠杆菌、产气杆菌、变形杆菌、绿脓杆菌、金黄色葡萄球菌、梭状芽胞杆菌等。值得注意的是,部分患者有胆管梗阻表现,但手术中无梗阻原因可查,有人认为其发病可能与Oddis括约肌功能失调有关。 2.发病机理:①正常胆汁是无菌的。胆管细菌来源有三种途径,即由肠道逆行进入胆管,由门静脉进入胆管,由胃、肠上部、胆囊淋巴管进入胆管。胆管梗阻,使胆汁淤积胆管内压力增加,细菌     

胆源性胰腺炎和胰胆管合流异常的关系

目的 探讨胆源性胰腺炎(ABP)和胰胆管合流异常(anomalous pancreaticobiliary ductalunion,APBDU)的关系.方法 选择ABP患者131例,入院后抽取静脉血检查总胆红素(TB)、ALT、AST、ALP,γ-GT.先行非手术治疗,待病情稳定后复查上述指标,然后择期手术,并行术中胆道造影,观察胰胆管合流情况.结果 131例ABP患者中发现APBDU 27例,占20.6%.其中胆总管汇入胰管(Ⅰ型)8例,占29.6%,胰管汇入胆总管(Ⅱ型)16例,占59.3%,复杂型(Ⅲ型)3例,占11.1%.经非手术治疗后,TB、ALT、AST、ALP、γ-GT含量均较入院时明显降低(P＜0.05),其中APBDU患者的ALT为(71.81±23.19)U/L,AST为(47.85±27.87)U/L,γ-GT为(52.86±31.49)U/L,仍明显高于无APBDU患者的(51.96±15.40)U/L、(40.77±16.58)U/L和(34.86±26.47)U/L(P＜0.05).结论 胰胆管合流异常足导致ABP的重要原因之一.     

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随着技术的发展 ,胆道疾病的诊断方法越来越多 ,如B超、CT、内镜下超声检查术 (EUS) ,特别是磁共振胆管胰管成像术 (MRCP)越来越多地应用 ,但直接造影术如经皮经肝胆道造影术(PTC)、内镜下逆行性胰胆管造影术 (ERCP) ,特别是后者仍是除手术与病理检查以外诊断胆道疾病的“金标准”。不过 ,能用其他无创技术诊断的胆道疾病 ,不要轻易选择单纯诊断性ERCP ,毕竟ERCP术后有并发症 ,特别是ERCP术后胰腺炎仍有 1%～ 7%的发生率 ,且有时是无法控制的。1　胆道疾病的内镜诊断适用于疑有肝脏、胆道和胰腺疾病的患者。其操作技术较复杂 ,…     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.     

Morphological and immunocytochemical heterogeneity of cultured pinealocytes from one-week-and two-month-old rats: Planimetric and densitometric investigations

Abstract: In vitro preparations of rat pinealocytes are widely used for biochemical analyses of signal transduction processes. This paper deals with morphological and immunocytochemical features of such preparations. Special attention was paid to the problems of whether pinealocytes represent a heterogeneous cell population and how such heterogeneity may develop during ontogeny. The investigations were performed with cells which were obtained from the pineal organ of one-week-and two-month-old rats, attached to synthetic peptide-coated coverslips or tissue culture chamber slides, and maintained under in vitro conditions overnight. The attached cells were then fixed with paraformaldehyde. These preparations yielded monolayers of spherical cells of different sizes; most cells were isolated, but some of them were aggregated and formed small clusters. On the average, the cells from the one-week-old animals were smaller than the cells from the two-month-old animals. Immunocytochemical demonstration of S-antigen, a pinealocyte-specific marker, showed that the majority of the cells from two-month-old animals were intensely or moderately labelled. Pinealocytes from one-week-old animals were less S-antigen immunoreactive. Only very few cells (less than 1% displayed glial fibrillary acidic protein (GFAP)-immunoreactivity. Planimetric investigations of the cell size and semiquantitative densitometric investigations of the intensity of the S-antigen immunoreaction revealed that (i) pinealocytes kept in vitro form a heterogeneous cell population, and that (ii) this heterogeneity increases during postnatal development from one-week-old to two-month-old animals. Two groups of pinealocytes can be distinguished based on their developmental fate: pinealocytes of one group grow dramatically, but show only a moderate increase in S-antigen immunoreactivity, and pinealocytes of the other group retain their size, but display a distinct increment in S-antigen immunoreacti vitv.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.